Provider Demographics
NPI:1407118268
Name:FLORIDA MOVEMENT THERAPY CENTER-BOCA RATON, LLC
Entity type:Organization
Organization Name:FLORIDA MOVEMENT THERAPY CENTER-BOCA RATON, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JODI
Authorized Official - Middle Name:
Authorized Official - Last Name:GRAY
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:561-883-7800
Mailing Address - Street 1:21065 POWERLINE RD
Mailing Address - Street 2:SUITE A2
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33433-2313
Mailing Address - Country:US
Mailing Address - Phone:561-883-7800
Mailing Address - Fax:561-883-7801
Practice Address - Street 1:21065 POWERLINE RD
Practice Address - Street 2:SUITE A2
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33433-2313
Practice Address - Country:US
Practice Address - Phone:561-883-7800
Practice Address - Fax:561-883-7801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-07
Last Update Date:2016-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT34362251G0304X
FLOT9734225XN1300X
FLSA5535235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatricsGroup - Multi-Specialty
No225XN1300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistNeurorehabilitationGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GL290AOtherMEDICARE PTAN